tbuckley/cabot-search huggingface dataset:
Abstract 13664: Cardiovascular Mortality in Brazil During the COVID-19 Pandemic: Comparison Between Underlying and Multiple Causes of Death
Authors: Bruno R Nascimento, Luiz G Passaglia, Pedro C Pinheiro, Antonio L Ribeiro, Luisa C Brant
Journal: Circulation (2022)

Introduction: COVID-19 has impacted cardiovascular disease (CVD) mortality worldwide due to avoidance of healthcare, health system collapse, and the direct CV effects, but detailed data from Brazil are still scarce. We aimed to evaluate the impact of COVID-19 pandemic on CVD mortality, stratified by age, sex and region of Brazil, comparing underlying (UC) and multiple causes (MC) of death. Methods: Ecological, time series study analysing CVD age-standardized death rates, from epidemiological weeks (EW) 10/2020 to 11/2021, using data from the Mortality Information System (SIM-SUS). CVD was defined as in ICD-10 Chapter IX, and considered if reported as UC or MC of death (UC + other causes reported in any line of death certificate) in separate analyses. Observed was compared to expected data (mean for the same EW of 2017-2019). Risk ratios (RiR) were analysed and 95% confidence intervals calculated. Results: Age-standardized CVD mortality rate as UC of death in the pandemic was 165.9 (95% CI 165.5 - 166.3)/100,000 inhabitants, similar to the expected: (165.6; 95%CI 165.2 - 166.2)/100,000, with a RiR=1.00; 95% CI 1.00 - 0.93). There was an increase in out-of-hospital mortality (18%) (RiR=1.18; 95% CI 1.17 - 1.19) and in deaths with ill-defined CVD causes (43%) (RiR=1.43; 95%CI 1.42 - 1.44), particularly in the out-of-hospital setting (51%). The increase in out-of-hospital deaths was more pronounced in the North (RiR=1.33; 95% CI 1.30 - 1.36) and Center West (RiR=1.26; 95% CI 1.23 - 1.30), regions with less prepared health systems. Conversely, in MC of death analysis, there was a 10% increase in CVD mortality (observed: 243.2 (95% CI 242.7 - 243.7), expected: 221.6 (95% CI 221.1 - 222.1)/100,000, RiR=1.10 (95% CI 1.09 - 1.10), noticeably in the out-of-hospital setting (19%). Steeper increasing trends also occurred in the North region (RiR=1.16; 95% CI 1.15 - 1.17), and in individuals ≥60 years (RiR=1.11; 95% CI 1.10 - 1.11), and among men (RiR=1.11; 95% CI 1.11 - 1.12) vs. women (RiR=1.08; 95% CI 1.08 - 1.09). Conclusions: During the pandemic, CVD mortality as UC of death remained stable in Brazil, contrasting with an increase when MC were considered. Higher out-of-hospital mortality, exacerbation of existing CVD by COVID-19, and competing causes of death may have contributed.
Abstract 14210: Heart Failure Hospitalizations and Mortality Outcomes in PV142I Transthyretin Cardiomyopathy Patients Treated With Tafamidis
Authors: Rahul Patel, Rebecca Steinberg, Austin Rim, Matthew T Brown, Sreeram Yalamanchili, Dhanish Revanth Rangaswamy Nandakumar, Kunal Bhatt
Journal: Circulation (2022)

Introduction: TTR amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure in the geriatric population. The pV142I (V122I) transthyretin gene mutation is carried in 3.4% of African Americans. It is the most common cause of hereditary ATTR-CM (hATTR-CM) in the United States with a median survival of 2.5 years from diagnosis. Tafamidis is a selective transthyretin stabilizer approved in 2019 that has been shown to improve survival in wild type and hereditary ATTR-CM with New York Heart Association class I to III symptoms. The impact of tafamidis treatment on heart failure hospitalization (HFH) and mortality outcomes in pV142I hATTR-CM requires further investigation. Hypothesis: Tafamidis decreases HFH and mortality in pV142I ATTR-CM. Methods: We conducted a retrospective chart review of patients diagnosed with ATTR-CM with pV142I mutations enrolled in Emory University's Cardiac Amyloidosis Clinic between January 2014 and February 2022. Kaplan-Meier (KM) curves stratified by tafamidis use were generated for mortality and first HFH within 2 years of initial diagnosis. Log-rank test was used to compare KM curves. A p-value &lt; 0.05 was considered significant. Results: 111 patients in our study have pV142I hATTR-CM, including 47 (42%) prescribed tafamidis and 64 (58%) who were not prescribed. The median survival was 616 [interquartile range 277-731] days for patients treated with tafamidis and 595 [216, 731] days for untreated patients. The median time to HFH with tafamidis was 464 [167, 685] days and 233 [41, 613] days for untreated patients. Patients with tafamidis use had both lower rate of mortality (p = 0.005) and HFH (p = 0.035) than those who did not. Conclusion: In patients with pV142I hATTR-CM within our cohort, tafamidis use was associated with lower rates of mortality and heart failure hospitalization. These findings are consistent with previously described benefits in a generalized ATTR-CM population.
Abstract 13173: Impact of Bicuspid Aortic Valve Morphology on Computed Tomography Valvular Calcification in Aortic Stenosis and Sex Differences
Authors: Zi Ye, Marie-Annick A Clavel, Thomas A Foley, Philippe Pibarot, Maurice E Enriquez Sarano, Hector I Michelena
Journal: Circulation (2022)

Introduction: Aortic valve calcification (AVC) is the key pathophysiology underlying aortic stenosis (AS). We aimed to assess computed tomography AVC in AS by valve morphology (bicuspid [BAV] vs. tricuspid aortic valve[TAV]) and sex. Methods: Retrospective study of patients with echocardiographic AS severity and AVC assessments within six months. Patients with &gt; moderate aortic regurgitation, prosthetic aortic valve, or indeterminate aortic valve morphology were excluded. Severe AS with high mean gradient (MG) was defined as aortic valve area (AVA)≤1cm2 or indexed AVA≤0.6 cm2/m2 + MG≥40 mmHg. Results: Of 2647 patients, 361(65% men) had BAV and 2286(59% men) had TAV, age 65±11 vs. 80±9 years(p&lt;0.001), AVA 1.07±0.42 vs. 0.90±0.25 cm2(p&lt;0.001), MG 41±16 vs.42±14 mmHg(p=0.4) for BAV and TAV, respectively. For both BAV and TAV groups, age, MG, and severe AS frequency were similar between women and men(all p≥0.06). BAV morphology affected AVC-AS severity and AVC-sex associations (p for interactions &lt;0.001): as AS severity increased, mean AVC difference became larger between BAV-men and TAV-men, but smaller between BAV-women and TAV-women. Similar patterns were observed in AVC density (AVCd, AVC divided by left ventricular outflow tract diameter)-AS severity and AVCd-sex associations (p for interactions &lt; 0.001). In patients with concordant AS severity and MG levels, the best BAV AVC-cutoff for detecting severe AS + high MG by area-under-the-curve analysis was 924 AU for BAV-women and 2851 AU for BAV-men, different from guideline-recommended AVC-thresholds (1200 for women and 2000 for men). The best BAV AVCd cutoff was 289 for BAV-women and 476 for BAV-men, similar to the cutoffs for patients predominantly with TAV (292 for women and 476 for men from Clavel MA JACC 2013). The BAV-AVC threshold identified more patients with severe AS than guideline-recommended threshold in BAV-women (84% vs 74%, p&lt;0.001), but not in BAV-men. Conclusions: Valvular calcium accretion in AS was different by valve morphology and sex. As compared to TAV, BAV-women exhibited the least calcification while BAV-men exhibited the highest. Such patterns may impact the sensitivity of guideline-recommended AVC thresholds for detecting severe AS in BAV patients.
Abstract 14286: Comparison of Enteric Coated Aspirin With Plain Aspirin on Effectiveness and Safety in the ADAPTABLE Trial
Authors: Mark B Effron, Amber Sleem, Amanda Stebbins, Lisa M Wruck, Guillaume Gravel, Daniel Muñoz, Richard N Re, Kamal gupta, Carl Pepine, Sandeep Jain, Saket Girotra, Jeffrey Whittle, Catherine Benziger, Peter M Farrehi, Kirk U Knowlton, Tamar S Polonsky, Matthew T Roe, Russell T Rothman, Robert A Harrington, William S Jones, Adrian F Hernandez
Journal: Circulation (2022)

Introduction: Many clinicians recommend enteric coated aspirin (EC-ASA) to decrease gastrointestinal bleeding (GIB) in secondary cardiovascular (CV) protection even though studies suggest decreased platelet inhibition with EC-ASA compared to uncoated “plain” formulations (P-ASA). ADAPTABLE was a large, pragmatic study, showing no difference in ischemic events or bleeding between 81-mg and 325-mg ASA and provides a large population to assess effectiveness and safety of EC-ASA versus P-ASA in CV patients. Methods: Participants (pts) from ADAPTABLE were re-grouped according to type and dose of reported ASA use at baseline. The primary effectiveness endpoint was the composite of myocardial infarction (MI), stroke, or death from any cause and the primary safety endpoint was major bleeding events (hospitalization for a bleeding event with use of a blood product or intracranial hemorrhage) analyzed between groups by ASA type and within groups by dose using multivariable Cox proportional hazards. Results: 15,076 pts were randomized to 81-mg or 325 -mg ASA were followed for a median of 26.2 months of whom 10,678 reported ASA type at baseline. Of pts reporting ASA type used, 69% used EC-ASA and were slightly older, more likely to be in the 81-mg cohort, be nonsmokers, have slightly more coronary artery disease, and have a slightly lower prior MI rate (Table). No other significant differences between the 2 cohorts were noted. There was no significant difference in the effectiveness or safety outcomes between the EC-ASA and P-ASA cohorts (Table). Within EC-ASA and P-ASA, ASA dose had no effect on effectiveness (interaction p = 0.41) or safety (interaction p = 0.07). Conclusion: Enteric coating did not significantly affect the primary effectiveness or safety endpoints in ADAPTABLE, regardless of ASA dose. More research is needed to confirm whether enteric coated aspirin formulations or newer formulations will improve ischemic and bleeding outcomes in patients with CV disease.
Abstract 14115: Multivariate Predictors of Long-Term Outcome From Ventricular Tachycardia Ablation in a Large Registry
Authors: Jatin Goyal, Brototo Deb, Thomas Le Menestrel, Hui Ju Chang, Fleur V Tjong, Albert J Rogers, Zahra Azizi, Samuel Ruiperez-Campillo, Ruibin Feng, Prasanth Ganesan, Tina Baykaner, Roy John, Marco V Perez, Alexander C Perino, Paul J Wang, Mohan N Viswanathan, Nitish Badhwar, Sanjiv M Narayan
Journal: Circulation (2022)

Introduction: It remains difficult to identify clinical risk predictors of long-term outcomes from VT ablation. Hypothesis: We hypothesized that analysis of detailed clinical and laboratory features in a large registry may enable prediction of long-term outcomes from VT ablation. Methods: 623 consecutive patients enrolled in our VT ablation registry with 50 prespecified features included in this study. Ablation strategy was left to the discretion of each operator based on each clinical scenario, and included entrainment, activation mapping, substrate modification or a combination of these strategies. Patients were followed up for 3 years. Recurrent VT (&gt;30 seconds, appropriate device therapy or repeat ablation) or death were determined by clinical follow-up plus natural language processing of device interrogation. Results: Follow-up was available in N=596 (age 58.7±14.8y, 32.3% female). The overall VT-free survival was 65.3% at 1Y and 50.4% at 3Y, and was lower in patients with cardiomyopathy, particularly if ischemic (Figure). There was substantial inter-patient variability. Multivariate predictors of 3-Y VT-free survival (Table) were heart failure and systolic dysfunction (Hazard Ratio [HR]: 2.01, P &lt;0.0001), chronic kidney disease (HR: 1.70, P =0.0004), obstructive sleep apnea (HR: 1.36, P=0.0307), and serum sodium (HR: 0.89, P=0.0506) and calcium (HR: 0.85, P =0.0045). 1-Y predictors were similar. Conclusion: We identify novel clinical features of 1- and 3-year VT ablation outcomes in a large well characterized registry. These combinations of clinical and laboratory factors may guide procedural planning, and should be validated in other registries.
Abstract 12853: Superiority of Intranasal Over Systemic Administration of a Soluble ACE2 Protein (ACE2 618-DDC-ABD) in SARS-CoV-2 Infected Mice
Authors: Luise Hassler, Jan A Wysocki, Ian Gelarden, Nigar Khurram, Vlad Nicolaescu, Anastasia Tomatsidou, Haley Gula, Glenn Randall, Dominique Missiakas, Jack Henkin, Daniel C Battle
Journal: Circulation (2022)

Introduction and Hypothesis. Our group and others are using soluble ACE2 proteins to combat SARS-CoV-2. We have previously reported prevention of mortality, improvement of lung and kidney injury and reduced viral loads in SARS-CoV-2 infected mice that received a novel soluble ACE2 protein with extended duration of action and increased binding affinity for SARS-CoV-2, termed ACE2 618-DDC-ABD. In our previous study, this protein was administered both intranasally (IN) and intraperitoneally (IP). Here we tested the hypothesis that IN is more protective than IP administration. Methods: Human ACE2 618-DDC-ABD was tested in a BSL-3 facility in mice transgenic for human ACE2 (k18hACE2), infected with 3x10 4 PFU SARS-CoV-2. One hour before viral inoculation, the first protein dose was administered followed by 2 consecutive doses 24h and 48h post viral inoculation, either IN or IP (n=10 each). Weight, clinical score and mortality were monitored. Results: In the vehicle-receiving group (BSA in PBS), mortality was 100% on day 5. By contrast, in the IN-group, mortality was reduced markedly to only 10% on day 5 and 14. In the IP-group, by contrast, mortality was 60% at day 5 and 100% at day 14 (fig). In the IP-group, day 5 clinical scores [median (range)] were worse than in the IN-group [3.0 (2.0) and 1.0 (2.0), respectively, p=0.0032]. Conclusions: This study confirms the dramatic improvement in survival in mice treated with an improved soluble ACE2 protein and demonstrates the superiority of IN over IP administration.
Abstract 13869: Outcomes of Right Heart Catheterization in Patients With ST-Elevation Myocardial Infarction and Cardiogenic Shock: A Nationwide Analysis From the United States
Authors: Mahmoud Ismayl, Andrew M Goldsweig, Elissa Altin
Journal: Circulation (2022)

Introduction: The role of continuous hemodynamic assessment with right heart catheterization (RHC) in the management of cardiogenic shock (CS) continues to be debated. There are limited data exploring the outcomes of RHC in patients with ST-elevation myocardial infarction (STEMI) and CS. This study aims to assess the outcomes of RHC in patients with CS secondary to STEMI. Methods: This is a retrospective study of the Nationwide Inpatients Sample database that identified patients hospitalized with STEMI and CS on mechanical circulatory support with percutaneous left ventricular assist device to compare outcomes in those treated with RHC versus no RHC. Our primary outcome was in-hospital mortality. Secondary outcomes included cardiac, renal, neurologic, and pulmonary complications, need for blood transfusion, hospital length of stay (LOS), and total cost. The trends of RHC utilization were also evaluated. Results: The total cohort included 11,235 patients hospitalized for STEMI and CS between 2016-2019, of which 4,180 (37.2%) underwent RHC. Despite the higher comorbidity burden in the RHC group, there was a trend towards improved in-hospital mortality with RHC compared to no RHC (42% vs. 46%, p=0.07). However, RHC was associated with significantly higher renal (61% vs. 55%, p=0.01) and pulmonary complications (67% vs. 59%, p&lt;0.001) and more blood transfusions (18% vs. 14%, p=0.005). There were no significant differences in cardiac (58% vs. 56%, p=0.19) and neurologic complications (6% vs. 5%, p=0.15) between both groups. The LOS was longer and the cost was higher with RHC. There was a trend towards increased RHC utilization from 2016-2019 (p&lt;0.001). Conclusions: Although non-significant, RHC in STEMI patients with CS is associated with reduced in-hospital mortality. Given the possible mortality benefit with RHC, further research is necessary to optimize utilization of RHC while reducing complications in STEMI patients with CS.
Abstract 13993: Sex Differences in Cardiac Structure and Function Following Acute Myocardial Infarction: Insights From the PARADISE-MI Echocardiographic Sub-Study
Authors: Xiaowen Wang, Maja Cikes, Brian Claggett, Karola Jering, Wilfried Mullens, Lars Kober, Pardeep S Jhund, Attila Kovacs, Yinong Zhou, Amil M Shah, Marc A Pfeffer, Scott Solomon
Journal: Circulation (2022)

Introduction: Women have a higher incidence of heart failure (HF) hospitalizations than men following acute myocardial infarction (AMI). The extent to which differential cardiac remodeling between men and women might account for this higher risk in women is poorly understood. Hypothesis: Women and men have differences in cardiac remodeling after AMI that are predictive of clinical outcomes. Methods: The Prospective ARNI versus ACE inhibitor trial to Determine Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI) trial randomized patients within 0.5 to 7 days of AMI complicated by left ventricular (LV) dysfunction, pulmonary congestion, or both to sacubitril/valsartan or ramipril. In the pre-specified echocardiographic sub-study, 544 participants were enrolled to undergo protocol echocardiography at the time of randomization and after 8 months. Results: At baseline, women (n=142, 26%) were older, more likely to have a history of hypertension, and less likely to have a history of MI. Women had a higher LV ejection fraction (LVEF), lower LV end-diastolic index (LVEDVi) and end-systolic volume index (LVESVi), and LV mass index, but no difference in left atrium (LA) volume index compared with men (Table). Women had better diastolic function compared with men. The absolute and relative changes in these echocardiographic parameters from baseline to 8 months were not significantly different between women and men. In univariate analyses, baseline LVEF, LVEDVi, LVESVi, LA dimensions and diastolic measurements are associated with primary outcome (Table). Conclusion: In PARADISE-MI, women have higher LVEF and lower indexed LV and LA chamber sizes compared to men following high-risk MI. The changes between baseline and 8-month in LVEF, LV and LA dimensions did not differ significantly between men and women, suggesting that differential cardiac remodeling post-MI may not account for the increased HF risk in women compared with men.
Abstract 12942: Are Adult Cardiac Patient Education Materials Comprehensible for Patients?
Authors: Lin Chen, Dominic Orosa, Habib Layoun, Mona Kakavand, Miza Salim Hammoud, Rashed Mahboubi, Serge C Harb, Tara Karamlou
Journal: Circulation (2022)

Introduction: Patients are increasingly using the Internet to obtain healthcare information. Considering 21% of cardiac surgery patients are minorities, 27.9% are in the bottom quartile of household income, and 70% have Medicare/Medicaid or no insurance, online patient educational materials (PEMs) should be accessible and written at a level easily understood by majority of patients. We performed a comprehensive analysis of readability of websites containing patient-centered resources across all adult cardiac surgery areas. Hypothesis: Methods: Online PEMs on cardiac surgical procedures (CSP) were collected from top 50 hospitals for cardiology and heart surgery ranked by US News and World Report as of December 1st, 2021. Text pertaining to CSPs was collected and divided into five procedural genres: mitral valve, coronary artery bypass, heart transplant, aortic valve, and aortic surgeries. Texts were analyzed using OleanderSoftware’s Readability Suite through the Raygor readability test. Results: N=282 articles met criteria for analysis. Online content for all 5 surgical genres were difficult to read, with mean (SD) grade level readability score for all content at 13.8 (3.1, panel a). The mean (SD) readability for mitral valve, coronary artery bypass, heart transplant, aortic valve, and aortic surgeries were 14.4 (3.0, panel b), 13.9 (3.3, panel c), 12.2 (2.7, panel d), 13.5 (3.1, panel e), and 14.3 (2.8, panel f) respectively. Online resources for content within the 5 genres required at least college reading level for comprehension. Conclusions: Online PEMs exceeded the sixth-grade level recommended by the American Medical Association and the second-grade level previous established at our institution in all included genres of adult cardiac surgery. Improving the readability of online PEMs in adult cardiac surgery will facilitate equitable access to high-quality care.
Abstract 13611: Association of Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young U.S. Adults
Authors: Yaa A Kwapong, Ellen Boakye, Safi U Khan, Sadiya S Khan, Michael C Honigberg, Allison G Hays, Khurram Nasir, Roger S Blumenthal, Michael J Blaha, Garima Sharma
Journal: Circulation (2022)

Introduction: Depression is a non-traditional risk factor for cardiovascular disease (CVD). Data on the association of depression and poor mental health with CVD and suboptimal cardiovascular health (CVH) among young adults are limited. Methods: We utilized data from 593,616 young adults (18-44 years) from the 2017-2020 Behavioral Risk Factor Surveillance System, a nationally representative survey of non-institutionalized US adults. Exposures were self-reported depression and poor mental health days (PMHD, categorized as 0 days, 1-13 days, 14-30 days poor mental health in the past 30 days), and outcomes were self-reported CVD (MI, angina, or stroke) and suboptimal CVH (≥ 2 risk factors: hypertension, hypercholesterolemia, overweight/obesity, current smoker, diabetes, inactivity, and inadequate fruit and vegetable intake). Using logistic regression, we investigated the association of depression and PMHD with CVD and suboptimal CVH adjusted for sociodemographic factors (and CVD risk factors for CVD). Results: The weighted prevalence of CVD was 2.5% (95% CI 2.4%-2.6%), and depression was 19.6% (95% CI 19.4%-19.8%). CVD was more common among young adults with depression than those without (fully adjusted odds ratio [aOR]: 2.28, 95% CI: 2.10-2.48, Fig. 1A). There was a graded association of PMHD with CVD. Compared with individuals with 0 PMHD, the odds of CVD in those with 1-13 PMHD and 14-30 PHMD were 1.49 (95% CI:1.36-1.64) and 2.26 (95% CI: 2.06-2.48)(Fig. 1B), respectively after adjusting for sociodemographic and CV risk factors. Individuals with depression had higher odds of suboptimal CVH (aOR: 1.77, 95% CI: 1.67-1.88)(Fig 1C) compared with those without depression, with a similar graded relationship observed between PMHD and CVH ( Fig 1D). Conclusion: Depression and poor mental health are associated with premature CVD and suboptimal CVH in young US adults. Prioritizing mental health may help reduce CVD risk and improve CVH in young adults.